- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.11 / $755.12 / $2,777.40
| Professional | | $344.11 | $755.12 | $2,777.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.85 / $526.85 / $526.85
| Facility | | $526.85 | $526.85 | $526.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.52 / $513.32 / $821.20
| Professional | | $263.52 | $513.32 | $821.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.02 / $408.76 / $634.45
| Facility | | $262.02 | $408.76 | $634.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.85 / $614.16 / $965.84
| Professional | | $376.85 | $614.16 | $965.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.58 / $812.89 / $936.75
| Professional | | $672.58 | $812.89 | $936.75 |